Starting over – and views of a Flat Earth
04 September 2017 | View comments

4th September 2017 | By David Jolley

First mists on the park yesterday to join the cobwebs which tell us autumn is here. Apples and beans collected and shared with friends and neighbours – and next Sunday we will hold a ‘Traditional’ (old fashioned) harvest festival with special breads, bales of straw and unashamed fresh vegetables, fruits and salad. It will be ‘Dementia Friendly’ in an inclusive rather than exclusive sort of way.

Schools will be back on Monday, with some children we know going to new schools. Our version of this is the recommencement of our Friday seminars. The introductory session says hello to new trainees and gives chance for others to catch up on summer adventures. We read through Don Williams’ piece from the Guardian – ‘the article that changed my view: Research – the enemy of scholarship’. The essence of his observations is that the pre-eminence of clinical work, support by respect for the wisdom of previous generations, with teaching firmly hung on case examples, has been usurped by academic research, supported by large grants. Involvement in research, receipt of multi-million pound grants and publication of multiple papers are the things which have greatest kudos and attract the highest salaries. It is a model which detracts from clinical work and clinical teaching. It drives services, via government and management interventions, from a paper base which often feels to be detached from the real world of patients and their need for continuity of care from mature clinicians in confident and secure teams.

The experiences and thoughts of the trainees amongst us were particularly interesting. We learned that another northern university has lost or given up its academic department – It was deemed to be failing by the university as it was sufficiently successful in bringing in grant monies – no regard for its influence on the quality of clinical work or teaching. This has led to the perception amongst trainees that ‘nothing is happening here’, and an exodus to other centres which retain their professors etc. Recruitment to psychiatry, including recruitment of doctors who will work with older people, is difficult enough, but it is possible in the longer run that this will prove to be a healthy change. Perhaps the ambition for all centres to house an academic department has gone too far. Many of us would agree that the extension of university status to former technical colleges, colleges of art and such, is at best a mixed blessing. Some rethinking might be worthwhile.

The perspective from a general practice trainee was that there is much less of a hierarchy. Certainly research is not given the dominant roll, with greater emphasis on guidelines, clinical teaching and audit. That too sounds a healthy arrangement, but we know that general practice, like psychiatry, has difficulty with recruitment. Tracing things back to source, we reflect that what is taught to medical students and how it is taught and by whom, is likely to mould the values of those being taught. So it is that increase in medical student numbers has not resulted in more opting for careers in the less fashionable disciplines of general practice, psychiatry and care of older people: more and more see themselves as high-tech wizards in the specialties of what was general medicine or general surgery. And though there are academic departments which shy away from their teaching responsibilities to free time for research, the teaching generally lauds their work. Who sets the examination questions? Who make the awards which give access to a career? So we have a range of thoughts on all this and are grateful to Don Williams for bringing the matter to the table. Our balanced view emerged as a wish to acknowledge the equal value of clinical work, teaching and research, maybe even management. Within this flatter landscape, individuals might give more time to aspects of their work at different periods in their careers. I wonder if and how we could get back to this.